A matter of conscience

A matter of conscience
There is a danger that conscientious objection will only be allowed when it can make little difference, writes Dr Keith Holmes

 

Conscious Objection in Health Care describes medical scenarios where clinicians refuse to engage in a clinical activity on the grounds that such participation would contravene their ethical moral or religious beliefs. While this may apply to a variety of areas, the most frequent scenarios include abortion, euthanasia, and physician assisted suicide.

The legal situation in Ireland in respect of conscientious objection and abortion is that any individual may refuse to participate in a scenario involving abortion, but must ensure, if they do so, that a speedy referral is made to a colleague who will carry out the  procedure. In other words, one must not frustrate the process by referring to a colleague who may also conscientiously object.

While employees of a Health Authority may object to carrying out a procedure, the Authority itself must ensure that the procedure can be carried out; in other words an individual may be a conscientious objector but an organisation, in receipt of public funding, cannot.

Judgements

St Thomas Aquinas, the renowned Dominican Theologian, described conscience succinctly as “the mind of man making moral judgements”. Christian and Catholic teaching is that one must obey one’s conscience absolutely, which can create a conflict with the law of the land. Therefore one is duty-bound to ensure that one’s conscience is as fully informed as is reasonably possible.

The secular under-standing of conscience rejects the notion of a higher authority. If one takes a utilitarian view, which seeks the benefit of the greatest number of people, it leaves a very vulnerable group, including the unborn, the elderly, the weak, and those less able to advocate for  themselves. In contrast, a faith-based perspective, as the Australian bioethicist Archbishop Anthony Fisher states, is that “all human beings matter, matter equally, and matter very much”.

Conscientious objection was first described in modern times in the US, when the Society of Friends (The Quakers) refused to participate in Military Service in the US Army on moral and religious grounds, and were granted exemptions. Subsequently, with the enactment of the Abortion Act in  the UK in 1967 and the legalisation of abortion in the US in 1973 when the Church Amendment was introduced, the notion of conscientious objection in health care gained traction

Why is conscientious objection a problem?

In essence, people reject conscientious objection on grounds that divide broadly into those which are philosophically based and those which are based on service delivery.

Those who object on a philosophical basis argue that there is no place for religion in the law, that religion, if one choses to engage in it, is a private matter, but should in no way interfere with how one carries out one’s job, and certainly not in contravention of the law of the land.

The argument against conscientious objection on the basis of service delivery is perhaps easier to understand. This argument states that if professionals object on whatever grounds, that they are creating a barrier to access of whatever service that might be.

This would inevitably lead to an inefficient delivery of service, might result in patient’s having to travel large distances, and indeed at times may result in professionals seeking to avoid the less appealing or more challenging aspects of their profession, by an appeal to conscience.

Conflict

Essentially it pitches conscience, which Article 18 of the Universal Declaration of Human Rights describes as a basic human right, in conflict with patient self-determination which others would see as being of paramount value.

It remains unclear as yet the extent to which Obstetricians and General Practitioners will evoke conscientious objection in cases involving abortion, and similar scenarios are likely to play out with euthanasia and doctor-assisted suicide into the future.

International practice suggests that conscientious objection can be allowed to professionals if they are in a sufficiently small minority. Nonetheless, the likelihood, as new practices become embedded, is that new applicants for senior positions are less likely to be successful if they have a clearly stated conscientious objection. This results in a dilution, over the years, of those who would be conscientious objectors

In addition, the law that stands challenges the notion of Catholic Health Care, whereby publicly funded organisation which provides services for a designated catchment area cannot shirk its responsibility under the law.

The argument against conscientious objection on the basis of service delivery is perhaps easier to understand”

In summary therefore, conscientious objection is well described, well recognised, and seen in many ways as being a basic human right. In the current dispensation, following the new legislation pursuant to the repeal of the Eighth  Amendment, and bolstered by a directive from the Medical Council, it is incumbent on doctors who conscientiously object to  carrying out  abortion to  nonetheless ensure a speedy referral to those who will, and thus finding themselves acting as agents, and working for an organisation which must itself ensure that such procedures are carried out.

We have a considerable deficit to make up until true conscientious objection is allowed, and sadly, as has been described, it will probably only come to pass when those who conscientiously object are such a minority that it makes little difference to the profession as a whole.

 

Keith Holmes is a Consultant Child Psychiatrist at the Lucena Clinic, St John of Gods. He is a past council member of the Irish College of Psychiatry and current President of the Irish Catholic Doctor’s Learning Network. www.icdln.com